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The latest legislative and regulatory activity that impacts you and the services we provide
Policy Matters Brief - May 4, 2023
Michigan auto fee schedule CPI adjustment
The Michigan Department of Insurance and Financial Services (DIFS) published an updated annual Consumer Price Index (CPI) medical component adjustment to be applied to the state’s auto no-fault medical fee schedules later this year. The adjusted percentage of 9.66%, for dates of service July 2, 2023 through July 1, 2024, applies to services and products reimbursed based on the 2019 auto no-fault reform law’s provisions for certain services/products without an applicable Medicare rate.
The 2019 reform law based reimbursement for most services and products on specific markups above the applicable Medicare reimbursement rates. However, for services and products covered under the fee schedule law but without an applicable Medicare rate, the law states that reimbursement to providers is to be based on a percentage reduction of the amount payable for the treatment under the person’s charge description master in effect January 1, 2019 or a percentage reduction of the average amount the person charged for the treatment on January 1, 2019 — both adjusted annually based on change in the medical care component of the CPI.
For the current fee schedule year, several of the services and products are only reimbursed at 54% of the provider’s applicable January 1, 2019 charge adjusted by the CPI percentage change. This percentage reduction is set by law to lower even further to 52.5% for dates of service after July 1, 2023. This lower reimbursement has continued to spark calls for legislative change to ensure providers are fairly reimbursed and access to care for auto claimants is not hindered.
Additionally, last year a Michigan appeals court ruling invalidated retroactive application of certain portions of the fee schedule provisions. The final legal decision is still pending a ruling on an appeal with the Michigan Supreme Court. For now, the specific fee schedule provisions may not be applied to claims for persons injured in accidents prior to June 11, 2019. One of the specific provisions halted for those older claims includes the capping of reimbursement for services without a Medicare rate to specific percentages of fees charged as of January 1, 2019.
Montana proposed updates to workers’ comp treatment guidelines and formulary
The Montana Department of Labor & Industry, Employment Relations Division has proposed updates to its medical treatment guidelines and drug formulary. These proposed updates would adopt the Montana Utilization and Treatment Guidelines, 8th Edition for medical services provided on or after July 1, 2023 and the April 2023 edition of the ODG Drug Formulary for prescriptions written on or after July 1, 2023.
The proposed updates to the treatment guidelines include low back pain and cervical spine injury. The proposed update for the ODG drug formulary would have minimal practical effect, as the Department is required by law to formally adopt a drug formulary annually. Existing regulations already state that the most current monthly version of the adopted formulary should be used.
A public hearing will be held virtually on May 18, 2023, and written comments may also be submitted. The notice of public hearing and public comment period, including the proposed rule text changes, can be viewed here. More on the guidelines can be viewed here, and information on the drug formulary can be viewed here.
Washington PTSD presumptive coverage rule amendments
The Washington Department of Labor and Industries (L&I) recently adopted rule amendments concerning mental conditions/disabilities to clarify when a presumption for post-traumatic stress disorder (PTSD) exists for certain firefighters, law enforcement officers, and emergency medical technicians. The amendments also note that telecommunicators can file an occupational disease claim for PTSD; however, it is not presumptively covered.
For more information on regulations and legislation we are tracking this year related to presumptive coverage, view our Legislative and Regulatory Tracker (select “Presumptions” as the Topic in the drop-down menu).
WCRI updates to workers’ comp pharmacy regulations national inventory
The Workers’ Compensation Research Institute (WCRI) recently released an updated 2023 version of its “Workers’ Compensation Prescription Drug Regulations: A National Inventory” publication. The report is a compilation of several regulations related to prescription drugs in all 50 states, with a particular focus on workers’ compensation, but it also touches on what WCRI characterizes as some of the most prominent prescription drug issues stakeholders are concerned about in 2023.
The report includes tables that provide a snapshot of various state regulatory provisions, both for prescription drugs in general and specifically when provided in the workers’ compensation systems. Topics include drug formularies, fee schedules, medical marijuana, and more. With any useful report like this, it is also important to remember that regulations in different states may vary considerably, impact workers’ compensation to different degrees, and are much more nuanced and detailed than can adequately be reflected in summary information placed in a table.